Extracorporeal Cardiopulmonary Resuscitation for Perioperative Cardiac Arrest: Study Unravels Characteristics and Outcomes

Recent study explored the outcomes of extracorporeal cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and perioperative cardiac arrest. It involved a retrospective review of perioperative extracorporeal CPR in adults. Out of 33 patients, 73% experienced cardiac arrest in the cardiac catheterization laboratory. The survival rate to discharge was 57.6%, with 89.5% having neurologically favorable outcomes. Factors associated with higher survival included shorter CPR time, lower lactate levels, and higher pH levels. The use of extracorporeal CPR in perioperative cardiac arrest demonstrated excellent survival rates with neurologically favorable outcomes in selected patients.

Comparison of Extracorporeal CPR with Conventional CPR

Compared to conventional CPR, extracorporeal CPR showed better potential survival outcomes for in-hospital cardiac arrest. Extracorporeal CPR in perioperative cardiac arrest had higher survival rates compared to in-hospital cardiac arrest. Important observations included the location of extracorporeal CPR events, with most occurring in the cardiac catheterization laboratory, potentially due to advanced monitoring and immediate interventions. Survival was not significantly influenced by the initial pulseless rhythm.

Factors Affecting Survival and Complications Post-Extracorporeal CPR

The study highlighted the importance of factors like lactate and pH levels in predicting outcomes, with lower lactate and higher pH levels associated with increased survival. Patient characteristics, such as ASA Physical Status and the presence of an anesthesia provider, also impacted survival rates. Complications like renal dysfunction, cardiovascular issues, and bleeding were common post-extracorporeal CPR, but did not significantly differ between survivors and nonsurvivors.

Potential of Extracorporeal CPR as a Rescue Therapy in Perioperative Cardiac Arrest

The research emphasized the potential of extracorporeal CPR as a rescue therapy in perioperative cardiac arrest cases, with higher survival rates compared to in-hospital cardiac arrest cases. Selection criteria, including clinical context, duration of CPR, and comorbidities, were discussed as crucial for identifying suitable candidates. The study noted the need for future research to optimize patient selection and timing of extracorporeal CPR initiation in perioperative settings.

Key Points

- Extracorporeal CPR demonstrated favorable outcomes in perioperative and in-hospital cardiac arrest cases, with a survival rate to discharge of 57.6% and 89.5% having neurologically favorable outcomes.

- Factors associated with higher survival included shorter CPR time, lower lactate levels, and higher pH levels in patients who underwent extracorporeal CPR.

- Extracorporeal CPR had better survival outcomes compared to conventional CPR in the setting of in-hospital cardiac arrest, with extracorporeal CPR in perioperative settings showing even higher survival rates.

- The location of extracorporeal CPR events, notably in the cardiac catheterization laboratory, potentially contributed to better outcomes due to advanced monitoring and immediate interventions.

- Factors like lactate and pH levels were significant predictors of outcomes post-extracorporeal CPR, with lower lactate and higher pH levels associated with increased survival.

- Extracorporeal CPR was highlighted as a potential rescue therapy in perioperative cardiac arrest cases, with discussion on the importance of selection criteria, patient characteristics, and identifying suitable candidates for optimized outcomes.

Reference –

Ashie Kapoor et al. (2024). Perioperative Extracorporeal Cardiopulmonary Resuscitation In Adults: A Single-Center Retrospective Review And Analysis.. *Anesthesiology*. https://doi.org/10.1097/ALN.0000000000005312.